H&HN Daily

Unified Vision + Right Culture = Improved HCAHPS

01.24.13 by Greg Winston, Brian Deaver

Creating a culture of excellence requires decisive action, perpetual pursuit of improvement and the right team members.

The leaders in your organization must clearly define, effectively communicate and consistently demonstrate their expectations for the organization's culture. It is their actions, words and behaviors that will allow the culture to flourish and take root.

It is not enough to demonstrate your goal or vision once in a while; you must consistently instill it in your staff to create a lasting impression of expectations. Hospital leaders need to make a personal and sustained participation by including dialog and alignment at every level within the organization.

By developing a culture that delivers superior employee and patient experiences, your hospital will enjoy exponential patient satisfaction and growth in Hospital Consumer Assessment of Healthcare Providers and Systems scores.

Right People with the Right Purpose

One important step in positively impacting patients' lives is having the right people on the team who all desire to work toward a consistent, common goal.

On a leadership level, the right people are those individuals who share in the same vision, who are passionate about creating the required culture and environment, who understand the perspective and expectations of the staff and patient, and who execute skillfully.

But the most critical positions are the team members who are interacting with the patients directly, delivering mission-critical services day in and day out. To patients, these individuals are the face of the hospital and may determine whether a care experience is viewed positively or negatively. Team members must exude compassion, understanding and caring with every patient and family member as if each patient were a member of their own family.

You would hope that doing what is right for patients and for the institution is its own motivation, but it often is difficult for employees to maintain; they tend to focus on tasks listed in their job description. The organization must evolve so that employees understand and embrace their true purpose, which is to serve the needs of the patients — through the functions in their job description.

Creating Change through a Shared Vision

While a CEO may clearly see a vision for the company's future success, the rest of the enterprise does not automatically share or understand the same vision. To some employees, "improved productivity" means doing more than they have been doing, usually with fewer resources. They view it this way because they have inadvertently locked on to practices that are inefficient.

Effecting change begins with assessing how employees view themselves and their contribution. Employees must be able to grasp the impact they have on the organization's success, to see how they contribute to the whole. They must understand the importance of their role and believe in the effort they are expected to make. There must be an alignment of goals and perspectives.

Social psychologist Leon Festinger believed cognitive dissonance is an uncomfortable psychological condition created when a person's experience contradicts or conflicts with their beliefs or attitude. Dissonance, however, can be used in a positive fashion. By helping the team become uncomfortable with the hospital's current performance and deciding together on a vision of what the hospital can be, personal goals can become organizational goals. A leader's awareness and support of an employee's personal goals ultimately leads to unity. Every human link in the organization's chain is required and must be maintained.

Experience shows that only 10 percent of employees are open to embracing new initiatives. Whether it is improving HCAHPS scores or a simple change in workflow, the challenge is the same: Employees must understand their capacity to do the job presented to them. As the vision is set for each employee, dissonance is triggered and a move toward a more positive self-image allows the employee to access more of his or her potential. As employees' confidence grows, they are more likely to engage in those activities that build toward a common good.

Model for Success

There are great examples across the country of greater engagement, outcomes and productivity that resulted from motivating team members at a personal level.

One such example exists in Lafayette General Medical Center. This community-owned hospital is a large full-service, acute care hospital in the Acadiana region of southern Louisiana. In 2009, Lafayette's employees began what they called their "journey to excellence" by holding a funeral for "old habits, bad attitudes and inefficient processes."

The funeral is an example of cognitive dissonance. For it to occur, employees had to acknowledge these habits, attitudes and processes. They committed to SERVICE (supportiveness, etiquette, respect, vibrancy, integrity, communication and excellence), the hospital's first-ever standards of behavior. They formed a standards team with the primary purpose of continually raising awareness and accountability for living and emulating the standards of behavior throughout the organization. This team's monthly campaigns were featured as a best practice at the 2010 "What's Right in Health Care" Studer Group conference.

The improvement was dramatic. In May 2010, Lafayette's overall HCAHPS rating was at the 27th percentile. By October 2012, Lafayette's HCAHPS score was at the 98th percentile.

Follow the Model

The approaches used to improve patient satisfaction by facilities like Lafayette provide a model to emulate:

Your top leaders' dedication to the patient experience strategy must be visible and unbreakable. Execution of the strategy requires daily pursuit and an expectation of 100 percent compliance and commitment to the standards set for your organization.

Measure and accept the brutal facts. As painful as it may be, identify how your organization compares with peer hospitals of similar size and function (children's hospital, safety net, teaching facility and so forth) and communicate the opportunity for change and improvement throughout the facility. Take the first step together as an organization. Follow Lafayette's approach and hold a mock funeral if that fits your culture, or do something else creative, memorable and effective to establish new standards and direction.

Be doggedly consistent in applying standards. Consistency is critical to building momentum and culture, as well as to achieving long-term results. Leaders and team members alike must be held accountable for creating an excellent patient experience. Performance improvement teams, like Lafayette's standards team, must be led by senior leaders who review results objectively and frequently, and act immediately on information. Leaders must understand how scores are compiled and address factors that will yield the greatest results in the shortest period of time. Ninety-day action plans are great, but do not put anything off for 90 days that can be accomplished immediately.

Realize that alignment is not always possible. There occasionally will be individuals who cannot align their personal goals with those of the overall organization. Your strategy must focus on getting the wrong people off the team as well as getting the right people on it. Make decisions about people quickly. You cannot afford to keep detractors on the team.

When everyone is pulling in the same direction and passion and accountability pervade, hospitals can rise from single-digit peer rankings to become a top performer in a matter of weeks.

Brian Deaver is an adviser for Outpatient Healthcare Strategies in Houston. Greg Winston is a corporate culture expert, author and speaker based in Laguna Niguel, Calif., and working in collaboration with Outpatient Healthcare Strategies.

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